Neglect
Introduction
Introduction to neglect Obstacles to the apparent "inattention" or perceived response of an object in the body or in the field of view are referred to as neglect. Some scholars believe that neglect can also be classified as aphasia in cognitive impairment, which is described separately here. Neglect phenomenon can be manifested in sports, physical sense, visual and auditory aspects, and often presents diversity, that is, patients have sensory, body image, space and motor neglect, and patients can only ignore one aspect. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: aphasia
Cause
Ignore cause
Cause:
The neglect is caused by the lesion of the right parietal lobe. The motor neglect is also seen in the lateral or lateral aspect of the frontal lobe, as well as the cortical or subcortical lesions in the temporal region, the lesions in the thalamus, caudate nucleus, putamen and sac. Can also cause motor neglect, sensory neglect and unilateral spatial neglect, often caused by non-dominant hemispheres under the lobule or posterior thalamic lesions, also seen in the dominant hemisphere parietal, frontal and lateral sides of the frontal lobe, The basal nucleus and the posterior limb of the internal capsule are lesions. The most common cause of neglect is cerebrovascular disease, which is also seen in brain tumors, brain trauma and brain stereotactic destruction.
Prevention
Ignorance prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Ignore complications Complications
This disease is generally uncomplicated.
Symptom
Ignore symptoms common symptoms unilateral inattention hemianopia sensory disorder motor neglect unilateral spatial neglect vertical neglect
Classification and lesions:
1. Motor neglect The patient uses only one hand to do the right hand to do things and gestures, while the other hand usually has the left hand seems to have been forgotten and left idle. Does not swing or rarely swing, like a patient with a half-side Parkinson's disease, when the affected arm is in a very uncomfortable position, it remains motionless for a long time, and the lower limb is neglected, which is manifested as an obstacle often hitting the affected side during walking. When he put a pair of shoes in front of him, he asked him to wear only one of the healthy side and ignored one of the affected side.
The method of examination for exercise-induced neglect is to make the patient perform double-sided repetitive movements. For example, the patient is required to open and hold the two fists at the same time for 20 consecutive times. The normal person can perform repeated simultaneous movements without error, and the patient has one side. Do it continuously and do not do it on the other side or obviously leak it.
When the stimulus ignores the side limb, whether it is acupuncture, licking or pinching the skin, or flexing the side ring finger hard, the patient will say pain, but it does not retract the hand; thus the patient is not harmful The perception of stimuli is an obstacle, but a barrier to responding to noxious stimuli, a valuable sign common in motor ignorance.
Clinically, pure motor neglect is rare, often with a certain degree of sensory neglect, but always with obvious dyskinesia and mild sensory disturbance.
2. Sensory neglect (sensory neglect) is also called hemi-inattention, which can be somatosensory, visual or auditory. At this time, the patient cannot be directed to the stimulus from the lesion side. No response or report can be made; the patient's lesion does not destroy the sensory afferent pathway or damage the primary sensory cortex or the thalamic sensory nucleus.
Sensory neglect is usually expressed in the form of sensory extinction. The definition of sensory regression is that when the two sides are equally stimulated, the patient does not feel the stimulation on one side; but the left and right stimulation are respectively given. The patient can feel it.
3. Hemi spatial neglect (also known as hemi spatial inattention or unilateral visual neglect), unilateral spatial neglect is often accompanied by left lateral isotropic hemianopia But the latter is not essential.
Patients with unilateral spatial neglect, manifested as one side of the thing, often in the left side of the field of things do not pay attention: ask him to read a newspaper in the column heading, he read only the right half and ignore the left half; Ask him to count the number of people standing in front of his bed. He only counted the right and front, and ignored the person on the left.
4. Vertical neglect The patient does not see the lower part of the object in front, and the vertical direction of the wood is measured by visual, tactile, and visual-tactile bisects. Compared with the normal control, the patient The midpoint of the finger was obviously moved upwards, and the bilateral apical occipital lobe lesions may have a multi-type neglect of vertical plane.
Examine
Neglect check
1. Blood routine, blood biochemistry, electrolyte attention to the specific changes in the diagnostic value of the primary disease.
2. Blood sugar, immune items, cerebrospinal fluid examination, if abnormal, there is a differential diagnosis.
3. CT, MRI examination.
4. EEG, fundus examination.
5. Skull base film.
Diagnosis
Ignore diagnosis
Some scholars believe that neglect can be classified as aphasia in cognitive impairment. Objectively speaking, neglect is very similar to autologous and spatial agnosia, so clinical diagnosis and identification are not easy, and the identification points are similar to aphasia.
Patients do not have vision, hearing, physical sensation and disturbance of consciousness. They must be carefully examined by the nervous system to rule out that some abnormalities are caused by other reasons.
